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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400251
Report Date: 07/15/2022
Date Signed: 07/15/2022 10:28:53 AM

Document Has Been Signed on 07/15/2022 10:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CUEVAS FAMILY CHILD CAREFACILITY NUMBER:
198400251
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 4DATE:
07/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria De Jesus Cuevas, LicenseeTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required – 1 Year inspection to the above facility on 07/15/2022 at 9:00 AM. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Maria De Jesus Cuevas, who guided the LPA on a tour of the facility. Adults in the home were discussed and all have criminal record clearance. There were four day care children present during today’s inspection, two of which were infants. Licensee states that there are currently three children enrolled. The children's roster was reviewed and is current. Per Licensee, the facility’s hours of operation are Monday thru Friday, 6:00 AM to 6:00 PM. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 06/06/2022. LPA observed a dog upon entry of the home being kept in dog cage in rear off limits area of home, per Licensee dog is kept away from children during daycare hours.

This is a single-story home which consists of three bedrooms and two bathrooms, kitchen, living room, dining room, and detached garage. Main Care Areas used by the children include the Living Room (located upon entry of the home), Dining Room (located next to Living Room), and Bathroom 1 (located to the left of Living Room). Per Licensee, areas off limits to children and parents include kitchen and entire rear of home that includes all bedrooms and Bathroom 2. At 9:10 AM, LPA observed that there is a baby gate separating areas used by children and off-limits area. At 9:11 AM, LPA observed a child safety door knob on Bedroom 1, making it inaccessible.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed central air and ceiling fans through out the home. There is a working telephone maintained in the home. At 9:04 AM, LPA observed Living Room to have two couches, play kitchen, tall doll house, and other age appropriate toys,
free of loose and sharp parts available for children. At 9:05 AM, LPA observed Graco Pack-n-Play and wooden crib in Living Room used for Infant sleep. At 9:07 AM, LPA observed Dining Room to have circular
Report continues- Page 1 of 3
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CUEVAS FAMILY CHILD CARE
FACILITY NUMBER: 198400251
VISIT DATE: 07/15/2022
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dining table with four chairs, shelving unit with bins filled with art materials, board games, and other age appropriate toys. At 9:10 AM, LPA observed Bathroom 1 to have operable toilet and sink, adequate handwashing and toileting supplies, floor free of hazards, under cabinet sink to have operable child safety lock, medicine cabinet used for storing toothbrushes, and storage unit over toilet to have toileting supplies. LPA observed electrical cover outlets all through the home. Detergents, cleaning compounds, medications, sharp knives and utensils, and other items which can pose a danger to children are inaccessible. The Licensee states that there are no poisons in the home. The Licensee does understand that poison must be locked with a key or combination lock. At 9:21 AM, LPA observed these items to be stored in off limits Kitchen area with operable child safety locks. Per Licensee, they provide food for children in care.

Per Licensee, the children will have access to side yard area for outdoor play. At 9:17 AM,LPA observed side yard has concrete through out, shade, and adequate perimeter fencing through-out the yard. LPA observed side yard is accessible through side door in Kitchen. LPA observed plastic play house, ride along toys, and other age appropriate toys free of loose and sharp parts available for the children in the side yard. At 9:18 AM, LPA observed there is a pool in the backyard of the home. Licensee states rear of the backyard is off limits to children in care. LPA observed a babygate making backyard off limits. At 9:19 AM, LPA observed a gate 5 feet tall, with door swinging outward to have self latching lock and to be locked with a key at time of inspection. At 9:20 AM, LPA observed detached garage and storage shed in backyard that Licensee states is used for storage.

Per Licensee, there are no weapons, firearms in the home and LPA observation did not observe any weapons or firearms at time of inspection.

At 9:26 AM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with proof of purchase receipt on 11/26/2021. At 9:28 AM, LPA observed smoke and carbon monoxide detectors are in operable condition at time of inspection. At 9:29 AM, LPA observed first Aid kit is kept in the Kitchen. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training
—CPR Card valid until: 03/2024
—Mandated Reporter AB1207 Completed: 04/28/2021
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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CUEVAS FAMILY CHILD CARE
FACILITY NUMBER: 198400251
VISIT DATE: 07/15/2022
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The following were discussed:
Incidental Medical Services (IMS)
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee (or facility representative) was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility.



The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today 07/15/2022.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Maria De Jesus Cuevas.

Report ends- Page 3 of 3

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3